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Pediatric Endocrine Flashcards

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1
Q

What are most endocrine disorders caused by in children?

A

Insufficient production of hormones

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2
Q

When is hormonal control over most of the body systems complete?

A

12-18 months (correlates with neuro system)

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3
Q

When does puberty normally begin for boys?

A

Usually 11

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4
Q

When does puberty normally begin for girls?

A

Usually around age 9

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5
Q

What is an example of the negative feedback system?

A

When hormones are low then the endocrine gland will receive message then target cell will sense this and release stimulating hormone

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6
Q

Why are magnesium levels important?

A

Help regulate the heart and can cause arrythmias if off balance

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7
Q

What other electrolyte correlates with magnesium?

A

Potassium (if magnesium is high so is potassium)

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8
Q

Why do you measure growth in children with an endocrine disorder?

A

To assess growth pattern over time

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9
Q

What facial characteristics do you look for in children with an endocrine disorder?

A
  • Protuberant tongue and eyes

- Moon face

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10
Q

What do assess in the neck for children with an endocrine disorder?

A

Enlarged thyroid or goiter

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11
Q

What do you assess with the genitalia and secondary sex characteristics in children with an endocrine disorder?

A
  • Ambiguous genitalia

- Determine stage of development related to sex characteristics

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12
Q

What do you note in skin assessment in children with an endocrine disorder?

A

Areas of unusual pigmentation

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13
Q

Where does growth hormone work?

A

Bone and Muscle

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14
Q

Where does prolactin work?

A

Mammary glands

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15
Q

Where does follicle-stimulating hormone and luteinizing hormone work?

A

Testes and Ovaries

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16
Q

Is there delayed linear growth with GHD?

A

Yes

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17
Q

True or False: GHD is most often idiopathic.

A

True (75%)

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18
Q

True or False: Most children with GHD will have subnormal intelligence.

A

False (treated younger than they are but normal intelligence)

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19
Q

True or False: GHD occurs more often in males.

A

False (they just seek treatment more)

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20
Q

True or False: Decreased activity of the pituitary gland contributes to GHD.

A

True

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21
Q

True or False: Growth is normal during the first three years in a child with GHD.

A

False (normal for first year and then it falls)

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22
Q

True or False: Weight is more retarded than height in children with GHD.

A

False

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23
Q

True or False: Children with GHD will have delayed bone maturation during infancy and childhood.

A

True

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24
Q

Where are children with GHD at on the growth chart?

A

Below the 3rd percentile

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25
How much do children with GHD grow a year?
Less than 2 inches
26
What happens to teeth eruption in children with GHD?
Primary teeth come in but permanent teeth are delayed
27
What happens to sexual development in children with GHD?
Delayed
28
What are the vocal qualities of children with GHD?
High-pitched
29
What is the facial appearance of a child with GHD?
Childlike
30
What is a major problem in children who have GHD?
Slipped Capital Femoral Epiphysis*
31
On the growth chart what is considered too big and what is considered too small?
Big: >90% Small: <3%
32
What is the management of children with GHD?
- Growth plotting - Treat age appropriate - Help adjust to issues
33
When should you administer GH therapy to a child with GHD?
At bedtime
34
When does physiologic release of GH occur?
During the first 45-90 minutes after onset of sleep
35
How effective is GH therapy?
80%
36
How do you administer GH?
Daily Subcutaneous
37
When is treatment with GH often stopped?
At closure of the growth plates or when growth is a year
38
What are the symptoms associated with GH?
- Myalgia - Arthralgia - Gynecomastia - Sodium retention
39
How do you measure the height of children under 2?
Supine measuring board
40
How many people are required to do a supine growth measurement?
2
41
What do you teach patients and children with GHD?
How to measure growth and reconstitute drugs
42
The nurse is talking with the teacher of a child who has GHD. As an advocate for the child, the nurse will most need to talk about which of the following needs of the child?
To be spoken to at an age-appropriate manner
43
What is precocious puberty defined as in Caucasian girls?
Breast development before age 8
44
What is precocious puberty defined as in African American girls?
Breast development before age 6
45
What is precocious puberty defined as in boys?
Development of secondary sex characteristics before age 9
46
What is precocious puberty caused by?
Premature activation of the hypothalmic-pituitary gonadal axis that stimulates LH and FSH
47
What is the most frequent cause of precocious puberty in females?
Idiopathic (97%)
48
If you see early growth development in boys what test needs to be done?
MRI or CT
49
What is most often the cause of early growth development in boys?
Brain tumor
50
What do you need to look at in girls that are showing early growth development?
Beauty products and BC
51
What are the clinical manifestations of children with precocious puberty?
- Increased growth rate - Advanced bone age - Evidence of secondary sex characteristics - Acne - Body odor - Behavior changes
52
What diagnostic tests do you use for precocious puberty?
- Pelvic ultrasound - MRI - Hormone levels
53
What drug is available every 3-4 weeks, SQ or nasal spray for precocious puberty?
GnHR analog
54
How does GnHR work to treat precocious puberty?
Initially it will stimulate gonadotropin release, but when given long term it will suppress gonadotropin release
55
How do you know when GnHR treatment is effective at treating precocious puberty?
Development of secondary sex characteristics stops and may regress
56
What is one of the most common endocrine disorders in peds?
Juvenile hypothyroidism
57
What is the difference between congenital and acquired hypothyroidism?
Congenital deals with affected gland, acquired from autoimmune disorder
58
Who is juvenile hypothyroidism more common in?
Down Syndrome and Premature babies
59
Why do we always do a glucose screen on babies the second day after birth?
Because there are very few signs at birth
60
If hypothyroidism is not caught early what can it cause?
Mental retardation
61
What size posterior fontanel will babies have with hypothyroidism?
Large
62
What are some signs of hypothyroidism in children?
- Constipation - Jaundice - Hypotonia - Bradycardia - Hypothermia - Cool skin - Lethargic - Thick tongue - Hernia - Swollen eyelids
63
What do parents often report in a child that has hypothyroidism?
Extremely good and never cry
64
What are the 3 big indicators of hypothyroidism?
- Thick tongue - Swollen eyelid - Hypotonia
65
How do you diagnose hypothyroidism?
Newborn screening (2-6 days of life)
66
How does treatment differ in congenital and acquired hypothyroidism?
Congenital use rapid replacement and progressive with acquired
67
What medicine do we use to treat hypothyroidism?
Synthroid
68
What kind of formula interferes with the absorption of Synthroid?
Soy based
69
What are signs and symptoms of improper dosing with Synthroid?
-Hyperthyroid symptoms
70
When do you administer Synthroid?
1 hour before meals or 2 hours after
71
What are some issue adolescents face when they have hypothyroidism?
Attention Span difficulty and Visual Spatial defects
72
What is a common cause of hyperthyroidism in the pediatric population?
Graves disease
73
What are other causes of hyperthyroidism in peds?
tumors and infants of mothers with Graves
74
The nurse assessing a child with hyperthyroidism will most likely find what symptoms?
weight loss despite excellent appetite, overheating, tachycardia, and difficulty sleeping
75
Are bulging eyes usually seen in early adolescents?
no
76
Is a goiter usually seen in adolescents?
yes
77
What are common side effects of Propylthiouracil (PTU)?
rash, mild leukopenia, arthralgia, sweating
78
What could a fever or sore throat indicate when taking PTU?
granulocytopenia (due to leukopenia)
79
What are the main treatments for hyperthyroidism?
Propylthiouracil (PTU) and radioactive iodine
80
What academic performance considerations are there with hyperthyroidism?
difficulty staying on task, inability to sit still, may need PE modifications
81
What is congenital adrenal hyperplasia?
autosomal recessive adreno-genital syndrome due to a 21-hydroxylase deficiency and you are unable to tell sex of child
82
Are males or females more affected by congenital adrenal hyperplasia?
equal occurrence
83
What people group is CAH common in?
Native Alaskans
84
Are internal organs affected by CAH?
no
85
When will you know what the sex of the child is?
when ultrasound can tell in about a month
86
What are physical changes for males with CAH?
may see enlarged penis (adult-sized by school age but with normal testes size) and hyper pigmented scrotum and may be tall
87
When is CAH diagnosed in males?
May not see any physical changes so they may not be diagnosed until adrenal crisis
88
What are the physical manifestations of CAH in females?
virilization - enlarged clitoris, fusion of labial folds, rugated appearance of labia
89
If not diagnosed at birth, a newborn with 21-OH deficiency and salt wasting will develop which of the following problems by 10 – 14 days of life?
Adrenal crisis
90
What percentage of CAH are salt wasting?
70%
91
What are the electrolyte imbalances with salt-wasting CAH?
hyponatremia, hyperkalemia, a high urine sodium level and low serum and urinary aldosterone levels.
92
Will you see adrenal insufficiency with non-salt wasting CAH?
not unless stressed
93
Will you see precocious puberty with non-salt wasting CAH?
yes, you may see this
94
When may diagnosis of non-salt wasting CAH be delayed to?
age 3-7
95
What is the treatment for CAH?
Lifelong long replacement of steroids of adrenal glands
96
What do parents need to be taught with treatment of CAH?
how to administer steroids IM injections
97
What happens if steroids are not given for CAH?
accelerated height, early closure of the epiphyseal growth plate (stopping growth early)and premature sexual development.
98
Which steroids are given for CAH?
Glucocorticoid hydrocortisone dexamethosone, prednisone, hydrocortisone
99
When is reconstruction (mainly of the clitoris) done for CAH?
2-6 months
100
What are symptoms of adrenal crisis?
low BP, vomiting, low BS
101
The nurse is working with the parents of a newborn with CAH? Which of the following instructions should the nurse provide to the parents?
An assignment of the sex may be delayed
102
What is pheochromocytoma?
tumor of the adrenal glands
103
What age is pheochromocytoma normally seen?
6-14 years old
104
How do you diagnose pheochromocytoma?
24 hour urine
105
What is phenylketonuria (PKU)?
Abnormal metabolism of amino acid phenylalanine. | Autosomal recessive trait.
106
Who is PKU normally seen in?
Mostly Caucasion. Rare in blacks, Japanese or Jewish
107
What happens when there is a deficiency of the liver enzyme phenylaline hydroxylase, with normally breaks down the amino acid phenylalanine into tyrosine?
phen metabolite levels increase in the blood, leading to a musty odor to urine and body
108
what are manifestations children may have with PKU?
seizures, hyperactivity, irritability, vomiting and eczema like rash.
109
If treatment is not done quickly for PKU, what may it lead to?
mental retardation
110
When are kids tested for PKU?
after 2 days of age after they have had breast milk or formula – to see if they can break down protein
111
What is Turner syndrome?
cells are missing all or part of an X chromosome.
112
What gender only gets Turner syndrome?
females
113
What are symptoms of turner syndrome?
``` Swollen hands and feet Wide and webbed neck drooping eyelids infertility short height absent or incomplete puberty ```
114
What is Klinefelter syndrome?
one of a group of sex chromosome problems. It results in males who have at least one extra X chromosome
115
What are manifestations of Klinefelter syndrome?
``` tall thin, overly long arms, diagnosed in school years Higher risk of developing scoliosis slightly feminized physique gynecomastia osteoporosis ```
116
What is treatment for Klinefelter syndrome?
testosterone injection until 11 or 12
117
What is a metabolism disorder passed down through families in which the body cannot break down certain parts of proteins?
Maple Syrup Urine Disease
118
What does the urine smell like with maple syrup urine disease?
maple syrup
119
What are manifestations of maple syrup urine disease?
seen within 2 weeks of birth, breathing difficulty absent of Moro reflex
120
What is treatment for maple syrup urine disease?
strict diet, protein free, if advance then hemodialysis
121
what is a major complication of maple syrup urine disease?
mental retardation
122
What is the peak incidence age for children with diabetes?
10-15 (75% before 18)
123
What do you not give until age one because it triggers autoimmune response that destroys pancreatic beta cells?
cows milk
124
What has been linked to causing diabetes?
viruses such as rubella
125
What is a manifestation of type 2 diabetes in children?
acanthosis nigricans, hyperpigmented skin in the skin folds, school nurse might notice this on the neck
126
What are common symptoms of diabetes seen in children?
3 Ps, UTI or yeast infection, abd pain, N/V, bed-wetting, wt loss, frequent illness
127
If a child is going to gym, what should you do about insulin administration?
hold off
128
What should you do to the insulin pin before administration?
prime it
129
By what age should children be able to self inject?
8
130
What range is it ok to kids to have for their A1c?
6.5-8%
131
Do kids spill more ketones?
yes
132
When does hypoglycemia usually occur?
right before meals or at bedtimes or when insulin is peaking
133
How can young children be included with their insulin administration?
may choose finger, may get equipment out, may choose injection site, may push plunger….etc
134
What is the best way to combat non compliance in adolescence with diabetes?
peer support groups
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